NPIMap

Organization Active NPI

Wabash Valley Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Terre Haute, IN
National Provider Identifier
1376974527
Registry record updated Jun 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WABASH VALLEY HEALTH CENTER, INC.
Practice address
1436 Locust St
Terre Haute, IN 47807-1648
Phone
(812) 232-7447
NPI assigned
Dec 12, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Peter C. Ciancone
Title
President of the Board of Directors
Phone
(812) 240-6056

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1436 Locust St
Terre Haute, IN 47807-1648

Mailing address

1436 Locust St
Terre Haute, IN 47807-1648
Phone (812) 232-7447

Other identifiers 1

IdentifierTypeStateIssuer
201168600AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140331000857 IN Part A Provider - Federally Qualified Health Center (FQHC) 4880848530 Practice locations: Terre Haute, IN

Federally qualified health center certification: CCN 151928

Legal name
WABASH VALLEY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 14, 2014
Last certification
Apr 14, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 28, 2011 in IN
Enrollment address
1436 Locust St
Terre Haute, IN 47807-1648

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sarah Kearns Individual Corporate DirectorCoo Apr 1, 2022
W-2 Managing EmployeeCoo Apr 1, 2022
Gary Broyles Individual Corporate DirectorDirector of the Board of Directo Apr 19, 2013
Christopher Newlin Individual Corporate Director Apr 11, 2022
Tamara Pupilli Individual Corporate Director Apr 1, 2022
Peter C Ciancone Individual Corporate DirectorPresident of the Board Jul 28, 2011
Mike Smith Individual Corporate Director Apr 1, 2022
Christina Elliott Individual Corporate DirectorSecretary Treasurer of the Board Jul 28, 2011
Michael Eldred Individual Corporate DirectorVice President of the Board of D Jul 28, 2011
Julie Baesler Individual Corporate Director Apr 11, 2022
Robert Rhodes Individual Corporate Director Apr 1, 2022
Charles G Welker Individual W-2 Managing EmployeeChief Executive Officer Jan 20, 2014

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593043200000",
    "number": "1376974527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1436 LOCUST ST",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478071648",
            "telephone_number": "812-232-7447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 LOCUST ST",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478071648",
            "telephone_number": "812-232-7447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WABASH VALLEY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-12",
        "last_updated": "2020-06-25",
        "certification_date": "2020-06-25",
        "status": "A",
        "authorized_official_last_name": "CIANCONE",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT OF THE BOARD OF DIRECTORS",
        "authorized_official_telephone_number": "812-240-6056",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201168600A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Terre Haute, IN

Sources for this page

Verify at the official NPI Registry.